Therefore, for an agreement to be ONE CR, it must be important for the health care business`s business and for its sound business objective, without the recommendations being taken into account. In determining whether an MSA is a CR, health care companies should consider the operational requirements of the company, such as the size of the facility and the needs of patients, as well as the reason for the MSA, and avoid compensating them for the services already provided in the facility. In addition, health care companies should take into account the experience and expertise of the MSO that provides the services, with the lowest costs being the lowest for comparable services, and ensure that there is a written agreement between the parties on the terms of services. In addition to FMV, CR is a standard that implements health care companies that must comply with the legal requirements of the federal government. In the provisional Phase II of the final rule, the Centers for Medicare-Medicaid Services states that “an agreement will be considered “CR” in the absence of referrals if [it] would be economically reasonable, if a reasonable unit of similar type and size and a reasonable physician (or […] Group practice) of a similar size and specialty, although there were no potential designated recommendations for health services. 4 Health care companies face a number of legal and regulatory constraints at the federal and regional levels that affect their creation, operation, coding and settlement, and transactions. Federal fraud and abuse laws, particularly those related to the anti-kickback law (AKS) and physician self-deportation laws (the “Stark Act”), can have the greatest impact on the activities of health organizations. For example, MSOs should be particularly careful not to infringe AKS because of its tariff structure. In a 1998 expert report, the Office of Inspector General (OIG) expressed concern about the payment of MSO as a percentage of the collection or revenue generated by the implementation of marketing services13. A market approach analyzes royalties normally paid by similar companies for similar services in the market. This approach is often a specific reference to the VMF when the rate of services and the type of unit are comparable to the market data points. As a result, market-based analyses may be preferred for established market segments, such as ASAs and imaging centres, provided that MSA services are typical and comparable fees are available.

With the growth of MMAs in other health sectors, such as wound care and behavioural health, the market approach may be less relevant. This may be due to different and non-comparable pricing structures, lack of market data and/or unique services such as development, marketing or other consulting services. As telemedicine has exploded in many forms – teledermatology, telegerontology, teleconsultation, telepsychiatry and other fields of medicine and health – we also see […] Are physicians required to submit and verify certain surveillance documents to the state? MSOs may or may not be familiar with these requirements. In addition, state laws may limit physicians to monitor only professional activities in which they are experienced. These are important considerations for the doctor because it involves their license. Practical management has become popular with healthcare companies in recent years due to pressure within the healthcare sector to reduce costs, implement new technologies and comply with increasingly complex rules.5 Three (3) main types of MSO businesses exist, among them: Growing Pain in Your Health Practice or Healthcare Venture? We have many clinical practices and health companies come to ask us how to reduce the risk of anti-kickback and […] MS allows clinical staff to focus on patients, while providing sectoral expertise in reimbursement, quality reporting and supervision.